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Centene CEO Michael Neidorff. Photo: Steven Ferdman/Getty Images

Centene and WellCare have cleared all federal and state antitrust reviews, and today they finalized their merger — combining into the largest health insurer by membership, with 23.4 million covered people.

Why it matters: The health insurance industry gets a lot more consolidated with this deal, and competition will decline within state Medicaid programs and among federal Medicare plans.

The big picture: A combined Centene and WellCare essentially functions as a branch of state and federal governments, because almost all of its $100 billion in annual revenue flows from taxpayer-funded health care programs.

  • Two-thirds of revenue come from Medicaid, where Centene and WellCare serve as the insurance gatekeepers for low-income people in 30 states. The two companies always competed against each other in Medicaid bids.
  • A growing portion of the combined company's revenue stems from private Medicare Advantage plans and Medicare prescription drug plans.
  • WellCare doesn't sell any plans in the Affordable Care Act marketplaces, but Centene is the largest ACA insurer. Taxes subsidize a vast majority of those ACA premiums.

Between the lines: Centene had to sell some of its Medicaid and Medicare plans to alleviate competitive concerns raised by antitrust authorities, but those assets are just getting shifted to other dominant insurers.

  • CVS Health bought Centene's Medicare and Medicaid plans in Illinois, and Anthem acquired WellCare's Medicare and Medicaid plans in Missouri and Nebraska.
  • Health insurance is all about scale, and the biggest players are getting bigger.

Go deeper

Bryan Walsh, author of Future
Updated 5 hours ago - Technology

A dark view of the future of autonomous weapons

A still from the video "If Human: Kill ( )." Image: Future of Life Institute

A new short film warns of the coming risks posed by the development and proliferation of lethal autonomous weapons.

Why it matters: Drones with the ability to autonomously target and kill without the assistance of a human operator are reportedly already being used on battlefields, and time is running out to craft a global ban of what could be a destabilizing and terrifying new class of weapon.

Updated 5 hours ago - Politics & Policy

Omicron dashboard

Illustration: Shoshana Gordon/Axios

  1. Health: Coronavirus variant surveillance varies widely by state — Omicron cases confirmed in 5 U.S. states America probably won't lead the effort to understand Omicron.
  2. Vaccines: Omicron adds urgency to vaccinating world — Omicron fuels the case for COVID boosters — Moderna loses patent battles tied to COVID vaccine — Pfizer could have vaccine data for children under five by end of 2021, CEO says.
  3. Politics: Nevada to impose insurance surcharge on unvaccinated state workers — New Jersey GOP lawmakers defy statehouse COVID policy — Oklahoma sues Biden administration over Pentagon vaccine mandate — Omicron travel bans are sign of what's to come.
  4. World: WHO: Delta health measures help fight Omicron — COVID cases surge in South Africa in sign Omicron wave is coming — Germany approves new restrictions for unvaccinated people.
  5. Variant tracker: Where different strains are spreading.
Updated 11 hours ago - Politics & Policy

Prosecutors charge parents of Michigan school shooting suspect

Photo: Scott Olson/Getty Images

The parents of a 15-year-old accused of killing four students and wounding seven other people at a Michigan high school have been charged with four counts of involuntary manslaughter, according to court documents.

The latest: Lawyers for James and Jennifer Crumbley told the Detroit News they are "returning to the area to be arraigned," after law enforcement officials announced a search for the Crumbleys had been initiated.

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